• Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology
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• v.7 no.11
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• pp.525-536
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• 2017

Purpose: The aim of this study was to identify the factors influencing ICU (intensive care units) length of stay of adult patients with critical illness. Methods: This study was adopted descriptive design. 270 patients who were admitted to ICU in general hospital, Seoul were analyzed. Results: A total of 270 patients, 116 (43%) patients had stayed more than 5 days. The length of stay of intensive care unit was significant positive correlation with the FCI(Functional Comobidity Index) score(r=0.33, p<.001) and APACHE(Aacute Physiology and Chronic Health Evlauaion) II(r=0.19, p=.001). In multiple logistic regression, the predictors of ICU length of stay were admission route (p=0.013), FCI score (p<0.001), APACHE II(p=0.012). Conclusions: Heatlh care providers in ICU should be aware that patients who admit to emergency departments and have higher disease severity are more considered to reduce their ICU length of stays.

• 한국노년학
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• v.36 no.4
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• pp.1037-1058
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• 2016

This study aims to investigate the female caregivers'experiences of aggression by nursing home residents, and to identify the policy strategies for violence prevention referred by the female caregivers. A total of 121 female caregivers with more than 6 months of working experiences had participated in this study. Of these, 56.2% had experienced verbal aggression, 51.2% physical aggression, and 27.3% sexual aggression, which reveals that client violence toward caregivers in nursing homes was at an alarming level. Although, physical and verbal violences were mostly caused unintentionally, about a half of the sexual aggression were caused deliberately. Aggression occurred the most when caregivers were providing the following services: changing the diapers or clothes, giving a bath, and serving meals. It was found that 'hitting' was the most common form of physical aggression and it was 'swearing' and 'touching or physical contacting' in the case of verbal and sexual aggression, respectively. Though there was a difference depending on the type of aggression, the most frequent reactions against client violence were to start a conversation or calm down the nursing home residents, and to leave the scene or ignore the incident. This means that the caregivers are coping very passively through resolving the aggressions by themselves, or overlooking the situation. The most frequently recommended strategy to prevent resident aggression was to provide educational programs on violence prevention to nursing home residents and caregivers(42.7%). Compared to the previous studies, this study indicates some differentiated strategies to prevent violence in nursing homes, which include hiring male caregivers, assuring directors to pay closer attention toward caregivers, using refined language between caregivers and residents, and keeping caregivers to wear appropriate clothes. Based on the study results, some policy recommendations on the prevention of client violence in nursing homes were suggested.

• Journal of agricultural medicine and community health
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• v.35 no.3
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• pp.274-286
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• 2010

Objectives: The purpose of this study was to examine the effects of the rearing, health and nutrition services through intervention in GP-GC (grandparents-grandchildren) families. Methods: A structured questionnaire was administered in January 2008 and January 2009 to 55(70) grandparents of GP-GC families who received intervention services also GP-GC families that did not receive services. The study area was the city of Chunnam Province, South Korea. The intervention services were provided by electronic voucher one day per week. The questionnaire assessed the general characteristics of the grandparents, childcare stress and burden, health status (ADL, IADL, depression, subjective health status and fall index) and mini nutritional assessment(MNA). The data were analyzed using SPSS software and an F-test, Chi-squared test and t-test. Results: The stress of grandparents resulting from childcare was high, but depression in grandparents perceived by grandchildren was significantly lower in served GP-GC families than in non-served GP-GC families. Differences in scores of affection (t=2.12, df=116, p<.05), automatics (t=2.92, df=116, p<.01), realistic(t=2.24, df=116, p<.05), and level of depression(t=2.90, df=116, p<.01) were significant. Incidences of acute disease, IADL cognitive fuction and depression of grandparents were slightly higher. Intervention services for GP-GC families had an impact on the childcare attitude and health status of grandparents. The intervention services of nutrition for grandparents were not promoted, but the scoring for subjective nutrition status were statistically higher for the served group (t=18.230, p<.0001). Conclusions: This study found that intervention programs of childcare services and health and nutrition management are effective for grandparents of GP-GC families. Intervention services for GP-GC family should establish the political issue.

• Research in Community and Public Health Nursing
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• v.10 no.1
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• pp.70-79
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• 1999

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

• The Korean Journal of Emergency Medical Services
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• v.22 no.1
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• pp.7-19
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• 2018

Purpose: With the purpose of educating and producing outstanding paramedics by enhancing their competencies, this study aimed to make policy suggestions to re-establish the education system and improve the national examination and the certification scheme. Methods: This study used focus group interviews and questionnaires to collect data. Totally, there were 277 subjects, including experts from the education and field. Data were collected from September 9 to 20, 2016, and analyzed using SPSS 22.0. Results: To strengthen the curriculum of paramedics, this study suggested 27 courses with 94 credits as the standardized curriculum and derived 9 core competencies of paramedics. For the national examination, this study suggested consolidating written test subjects, adding scenario questions to practical tests, and applying critical criteria to simple practical tests that performs a procedure, grading these tests on a pass/fail basis. In addition, this study suggested converting certification into license, reflecting paramedics' healthcare job characteristics. Conclusion: The quality of emergency medical services in Korea will improve when those with core competencies that originated from the standardized curriculum based on the results of this study acquire their certification through the national test scheme, and the certification management system creates a virtuous cycle to further enhance paramedics' professionalism.

• Journal of Korean Academy of Nursing
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• v.3 no.3
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• pp.50-61
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• 1973

Despite the intensive family Planning program of the government, which has reduced the :average population growth to 2.0 percent in 1970, the continuing high fertility rates and poor family planning services in urban slum areas has been continually pointed out by various evaluation seminars. Thus, it was felt that a study of the current status of family planning in an urban slum population was needed. The aims of the study were to: (1) delineate the general characteristics of the urban slum population (2) discover the knowledge, attitudes, and practice of family planing. (3) determine what was felt to be the ideal number of children. (4) determine the status of induced abortion. A random stratified sample of 200 women was selected from a population of 3, 118 married women, 20-49 years of age, living in the Yonsei Community Health Project area and registered at the Yonhee Community Health Service Institute. The respondents were interviewed by the investigates, using a pretested questionary, from the period of October 1 to October 30, 1972. The findings of the Study were as follows: 1. Afore than half of the respondents were in the high fertility age group (25-34): of lower educational level (under primary School) : from rural areas: and with unstable sources of income. 2. The average respondent had 3.6 living children. 3. Most of the respondents had knowledge of contraceptive methods such as the Loop(78, 5%) and Oral pill (87.0%). 4. Seventy seven percent of the respondents recognized the Health Center as an available source for family planning. 5. About seventy percent of the respondents approved of family planning. 6. Eighty four point five percent of all the respondents answered that using contraceptives is harmful to maternal health. 7. Currently, 21.0 percent of the respondents were using contraceptives, while 40.0 percent of the respondents were current users or had used contraceptives. 5. Of the respondents who had ever stopped using contraceptives, 78.0 percent gave side effects as the reason they discontinued the method. 9. The average number of ideal children reported by the respondents was 3.5. 10. If they had only 2 daughters, 85.5 Percent of the respondents thought they must have more children. 11. Sixty nine point five percent of the respondents approved of induced abortion for unwanted pregnancies, while 34.5 percent of the respondents had experienced induced abortion for unwanted pregnancies. The mean number of induced abortion for unwanted pregnancies was 0.7. 12. The result of this study showed that such urban slum population would be one of the most important target of the family planning services, therefore further social-psychological researches with technical development on this area are recommended.

• Research in Community and Public Health Nursing
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• v.9 no.2
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• pp.280-290
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• 1998

This study was carried out to idenify the health problems and needs of crippled persons in order to develop a community based rehabilitation service program through public health center. Information on health problems and needs were obtained from 120 crippled persons staying at home by questionaire and a measuring ADL. The results were summarized as follows 1. Among 120 subjects, male crippled (70.3%) outnumbered female crippled (29.7%). Many crippled persons belonged to the 40-49 age group (33.6%) while others were over 60 years (17.4%). There were 36.8% crippled persons with an elementary education, 26.5% had completed high school, 14.5% had completed middle school. 31% of the crippled persons were employed but most of them had unskilled jobs. 80% of the respondents replied that their monthly income was under 800,000 won. 2. The major causes of their handicap were due to acquired factors(92%) such as accidents, in fectious & communicable diseases and chronic diseases rather than congenital factors(8%). Crippled persons who belong to the first grade of disabilities were 14.8%, the second grade 35.7%, the third grade 21.7%, the forth grade 12.2%, the fifth grade 12.2% and the sixth grade 3.5%. 3. This study measured the degree of the ADL of crippled persons by a modified Barthel Index including 11 items. 73.5% of them were fully independent, 8.5% required minimal help, 2.7% required moderate help, 6.0% required substantial help and 9.4% were unable to perform task. In response to the 11 items of ADL, crippled persons required more help in stair climbing, ambulation and bathing than in other items. 4. In responding to concerning health problems, 10.3% of the subjects replied with incontinence, 8.5% malnutrition, 7.6% fecal incontinence and bedsores 2.6%. Chronic diseases which needs treatment were chronic pain(61.0 %), hypertension(16.5%) and diabetes(16.5%) 5. To the question of what type of rehabilitation services subjects required, chronic diseases management(52.1%) and physical therapy (41.2%) were the highest. The most important social welfare services subjects required were economics support (51.3%) and introductions to job opportunities(42%).

• Korean Journal of Occupational Health Nursing
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• v.11 no.2
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• pp.108-120
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• 2002

This study analyzed the managerial efficiency of 11 organizations, the branch centers of a occupational health service organization in Korea, using the Data Envelopment Analysis (DEA) method. The DEA is a good method for evaluating health services since it can handle multiple inputs and outputs simultaneously, and also identify the sources and amount of inefficiency. The author approached this study using two efficient models: the monetary value model and the real value model. The DEA method based on the monetary value model included cost factors, while the real value model excluded cost factors. The input variables used were manpower of physicians, medical technicians, nurses, industrial hygienists and administrators; labor, maintenance, and material expenses. The output variables used were the number of medical examinations, workplace evaluations, group health management services and income from each service. The major results were as follows: First, in the monetary value model, 6 out of 11 organizations (54.6%) showed an efficiency score of 1.0, which means that they have been operating in very efficient ways. However, 5 organizations (46.4%) showed themselves to be relatively inefficient. Second, in the real value model, 7 out of 11 organizations (63.4%) showed an efficiency score of 1.0, which means they have been operating efficiently, while 4 organizations (46.4%) showed themselves to be relatively inefficient. Third, the reliability of DEA method were analyzed by comparing the results of the monetary value model and real value model. The results of 8 out of 11 organizations were same in terms of being efficient or not. Thus, the DEA could be a valid application method for occupational health service organizations. Fourth, the organizations that displayed common inefficiency in both the monetary value model and in the real value model 3, 9, and 10, were also considered to be managed inefficiency from expertise opinion. In summary, this study evaluated the efficiency of occupational health service organizations applying the DEA method with different variables, and found that the results of analysis could be valid in terms of both modeling and expert sense. In the future, the DEA method will be used as a useful tool to identify and evaluate the efficiency of occupational health service organizations through more applications and refinements.

• Health Policy and Management
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• v.9 no.1
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• pp.30-71
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• 1999

There has been a dramatic increase in public awareness regarding dementia during recent years. However, dementia remains a family affair and patients do not receive adequate care in Korea. This study aims to assist patients and their caregivers by establishing Home and Community based Long-Term Care in a city. The data collected for analysis include five main categories: dementia prevalence, limitations of daily activities of patients, burden of caregivers, the services that patient's family want to utilize, the resources that handle dementia in the community. Major findings can be summarized as follows: 1)The prevalence rate of dementia for elderly people is 13.1 per 100 persons. Alzheimer's disease amount to 38.9% of dementia patients and vascular dementia account for 36.7% of them 2)Eight out of ten patients have mild dementia. Almost all patients have normal ADL. IADL, however, shows different picture. In every items of IADL, about 60% of patients reveals some limitations. 3)The proportion of patients who had medical diagnosis is as low as 20%. Families of patients think dementia as normal aging process and medical doctors in the community do not give special concern to dementia patients. 4)Caregivers does not have proper social support. They suffer from long care time, experience large obstacles in respect of health, daily living, and social activity. 5)Health center and Community welfare center have launched some programs-consultation, home-visiting nursing, day care center, voluntary force mobilization and so on-for dementia patients. But they do not perform expected roles and functions because of lack of skilled personnels and inadequate coordination of relevant organizations for dementia care. 6)Families of dementia patients prefer home helper and home-visiting nurse to hospitalization. For the future, however, demand for institution-based long-term services will increase. We develope community dementia care model based on above findings as follows: 1)Health center execute community cardiovascular control program for the prevention of vascular dementia. 2)Refer to epidemiologic characteristics of patients and preference of family, the most urgent task for dementia care in this city is to expand and organize Home and Community based Long-Term Care. 3)For the continuous and comprehensive care, care plan for a patient must be prepared. Case management team should be builded to prepare this plan and coordinate relevant resources. 4)Special long-term care unit for dementia will be needed in a near future. This unit should have multiple functions, such as day-care center, short stay facility, training center for relevant personnels, besides long-term nursing home considering effective care of dementia and efficient operation of the facility. 5)Voluntary workers deserve their due efforts. Incentive mechanisms must be developed to activate voluntary activities.

• Korea Journal of Hospital Management
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• v.7 no.3
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• pp.44-62
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• 2002

Advanced surgical technology demands more precise, meticulous, and time-consuming procedures. In addition, the patient's preference of tertiary health providers makes over crowding of the University Hospitals. Therefore, it has been necessary to maximize utilization of the operating room of such hospitals to accommodate these requirements. This study, targeting 1,302 surgical cases performed in 22 operating rooms at a university hospital in Seoul from October 8 to November 1, 2001, analyzed reasons for delay, and factors that caused delayed use of operating rooms. This study also assessed that the rate of operating room use would increase if the sources for possible reform were improved. 1. Among total of 1,302 cases of surgery, the incidence of surgeries in which there were no time delays and no factors for delay were discovered is 71.4% or 930 cases: the incidence in which surgeries were delayed was 28.6% or 372 cases. 2. As results of logistic regression for delay, procedures involving women were delayed 1.4 times more frequently than those of men. Compared to Department A, Department B was 1.8 times more likely to be delayed, and Department H was 0.4 times less likely to be delayed. Regional anesthesia was 2.4 times more likely to be delayed than general anesthesia, and surgeries that PCA was applied were 0.6 times less likely to be delayed than those when it was not. Surgeries performed on the Thursday were 1.7 times more likely to be delayed than those performed on the Monday. Compared to surgeries performed between 07:00-07:59, those performed between 08:00-08:29 were 4.3 times higher. 3. The reasons for delay were related to surgeon, surgical department, patient, anesthesia, administrative system, sick ward, and support services. Among these, 5,755 minutes for 276 delayed cases could be resolved easily, and resolving delays of 3,320 minutes for 131 cases would be more difficult. Among the causes for delay that could be improved, delays due to patient's transfer and surgeon's factor were the most common, 21.6% and 17.4% respectively. 4. If resolvable delays are improved, pre-anesthesia room is administered, and regional anesthesia and PCA are done ahead of time, use of emergency operating rooms will increase, we can increase overall utilization by 4.09%, we will save 744 minutes a day, we can reduce the time the operation room is used after 4 PM by 35%, and we can resolve the operation cancellations due to insufficient operating rooms. For the increase in the use of operating rooms, we need to maximally decrease the delays that could be improved, by allocating block time based on used totals hours of elective cases, giving accurate information on surgery schedule, voluntary cooperation by staff participating in surgeries in reducing delay time, and the hospital management's will to improve delay.